Acute and Critical Care

Original Articles

Nursing
Engagement and perspectives regarding the family conference process when considering discontinuation of life-sustaining treatments among critical care specialist nurses: a nationwide cross-sectional survey in Japan: Akane Kato, Yuta Tanaka, Yoshiyuki Kizawa, Hiroaki Yamase, Asami Tado, Junko Tatsuno, Mitsunori Miyashita; Acute Crit Care. 2025;40(2):339-348. Published online May 20, 2025; DOI: https://doi.org/10.4266/acc.003096

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Abstract PDF: Background
Recognizing the importance of multidisciplinary collaboration during treatment family conferences is increasing in critical care settings. We aimed to elucidate how critical care specialist nurses engage in the family conference process in terms of the actual discussions held, the recommended topics, and their perspectives regarding transfer of critical care patients to general wards.
Methods
This self-administered nationwide survey was conducted between October and December 2020, targeting a random sample of 740 critical care specialist nurses. An anonymous questionnaire based on established guidelines and pilot tests was used to assess the level of engagement with the family conference process, content of discussions, considerations regarding withholding or withdrawing treatment, and perspectives concerning patient care location and discontinuation of life-sustaining treatments among the surveyed nurses.
Results
Of the 396 returned questionnaires (response rate, 51.9%), 384 were analyzed. Less than 35% of the nurses consistently participated in family conferences and ensured that decisions regarding withholding or withdrawing life-sustaining treatments were re-evaluated following the conferences. Discussions focused predominantly on the patients’ physical aspects, whereas the nurses believed that patients’ values and preferences should be discussed. More than 70% of the nurses supported transferring patients from critical care settings to general wards for end-of-life scenarios.
Conclusions
Critical care specialist nurses in Japan exhibit limited engagement in family conferences and often fail to address their patients’ values and preferences. Educational programs and enhanced interprofessional collaborations are warranted to improve nurse involvement in family conferences and ensure continuity of care between critical care and general ward settings.

Nursing
Nurses’ knowledge, attitude, and perceived barriers toward protective lung strategies of pediatrics mechanically ventilated patients in a tertiary care hospital in Pakistan: Tasnim Zainib, Salma Rattani, Nimira Asif, Hussain Maqbool Ahmed Maqbool; Acute Crit Care. 2025;40(1):128-135. Published online February 19, 2025; DOI: https://doi.org/10.4266/acc.004761

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Abstract PDF Supplementary Material: Background
Protective lung strategies (PLS) are guidelines about recent clinical advances that deliver an air volume compatible with the patient’s lung capacity and are used to treat acute respiratory distress syndrome. These mechanical ventilation guidelines are not implemented within intensive care units (ICUs) despite strong evidence-based recommendations and a dedicated professional staff. Nurses’ familiarity with clinical guidelines can bridge the gap between actual and recommended practice. However, several barriers undermine this process. The objectives of this study were to identify those barriers and explore the knowledge, attitudes, and behavior of ICU nurses regarding the implementation of PLS.
Methods
This was a descriptive, cross-sectional study. The participants were nurses working in the six ICUs of a pediatric tertiary care hospital in Lahore, Pakistan. Using purposive sampling with random selection, the total sample size was 137 nurses. A summative rating scale was used to identify barriers to the implementation of PLS.
Results
Overall, the nurses’ barrier score was high, with a mean of 66.77±5.36. Across all the barriers subscales, attitude was a much more significant barrier (35.74±3.57) to PLS than behavior (6.53±1.96), perceived knowledge (17.42±2.54), and organizational barriers (7.08±1.39). Knowledge-related barriers were also significantly high.
Conclusion
This study identified important barriers to PLS implementation by nurses, including attitudes and knowledge deficits. Understanding those barriers and planning interventions to address them could help to increase adherence to low tidal volume ventilation and improve patient outcomes. Nurses’ involvement in mechanical ventilation management could help to safely deliver air volumes compatible with recommendations.

Nursing
Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan: Khaldoun Mohammad Hamdan, Ahmad M. Al-Bashaireh, Mohammad Al-Dalahmeh, Ahmad Rajeh Saifan, Maha Alkaid Albqoor, Abeer M. Shaheen; Acute Crit Care. 2023;38(4):469-478. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00430

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11 Web of Science
14 Crossref

Abstract PDF

Background
There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study’s purpose was to examine nurses’ knowledge and attitudes toward palliative care.
Methods
A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data.
Results
We measured nurses’ knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type.
Conclusions
ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.

Citations

Citations to this article as recorded by

The effect of moral distress experienced by intensive care nurses on end-of-life care attitudes and care behaviours: a single-centre cross-sectional and correlational study
Pakize Özyürek, İbrahim Kılıç, Ahmet Akarsu, Öznur Gürlek Kısacık
BMC Nursing.2026;[Epub] CrossRef
The relationship between nurses’ perceptions of spiritual care and their attitudes towards death and care of dying patients
Sevde Yuksel, Zeliha Koç
Palliative and Supportive Care.2026;[Epub] CrossRef
Core competency in palliative care among intensive care unit nurses: A latent profile analysis
Qin Guan, Xiaoling Zhu, Zhipeng Xue, Mengyun Peng
Nursing in Critical Care.2025;[Epub] CrossRef
Knowledge, attitudes, and self-efficacy regarding palliative care among Palestinian nurses in intensive care units
Bilal Awad, Ahmad Batran, Malakeh Z. Malak, Ahmad Ayed, Anas Shehadeh, Bahaa Alassoud, Moath Abu Ejheisheh
BMC Nursing.2025;[Epub] CrossRef
Soulful support: Exploring critical care nurses' spiritual caregiving towards end‐of‐life scenario
Ayman Mohamed El‐Ashry, Sameh Eltyebani, Shimmaa Mohamed Elsayed, Mahmoud Abdelwahab Khedr, Mona Metwally El‐Sayed, Mohamed Adel Ghoneam, Haitham Mokhtar Mohamed Abdallah
Nursing in Critical Care.2025;[Epub] CrossRef
Palliative Care Knowledge, Attitudes, and Self-Competence of Nurses Working in Hospital Settings
Mona Ibrahim Hebeshy, Darcy Copeland
Journal of Palliative Care.2025;[Epub] CrossRef
Towards enhancing palliative care competencies through comprehensive training for nurses and physicians in resource-limited settings: a cross-sectional study
Mohammad Alhaddar, Heba Falna, Haya Sultan, Hammoda Abu-Odah, Mohammad Khleif, Shahenaz Najjar
BMC Nursing.2025;[Epub] CrossRef
Empowering critical care nurses: bridging knowledge gaps in palliative care
Halima A. Almahrizi, Fawwaz Alaloul, Ohood K. Al Mamari, Esther K. Rani, Zayoon A. Al Mahrizi, Salma A. Al Harthy, Zakariya Al-Naamani
BMC Nursing.2025;[Epub] CrossRef
Spiritual and cultural influences on end-of-life care decision-making: a comparative analysis of the Arab Middle East and the United Kingdom
Hanan Hamdan Alshehri, Chris McParland, Hibah Abdulrahim Bahri, Bridget Johnston
Current Opinion in Supportive & Palliative Care.2025; 19(4): 242. CrossRef
The Correlation Between Nurses' Knowledge and Attitudes and the Provision of Patients' Spiritual Care in the High Care Unit
Hidayatul Rahmi, Rebbi Permata Sari Rebbi, Revi Neini Iqbal, Willady Rasyid
Journal of Health Sciences and Epidemiology.2025; 3(1): 51. CrossRef
Knowledge of undergraduate nursing students about palliative care
Aruna Jothishanmugam
Journal of Education and Health Promotion.2025;[Epub] CrossRef
Investigation of the Relationship between Personality Traits of Intensive Care Nurses and Their Attitudes and Behaviours towards End-of-life Care
Fırat Demir, Cansu Polat Dünya, İlknur Özkan
Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi.2024; 6(3): 243. CrossRef
Knowledge and attitude towards palliative care and associated factors among nurse: a cross-sectional descriptive study
Saeedeh Rafiee, Ismail Azizi-Fini, Zahra-Sadat Banihashemi, Safoura Yadollahi
BMC Nursing.2024;[Epub] CrossRef
Knowledge, Attitudes, and Determinants of Palliative Care Among Nurses: A Descriptive Study
Kalkidan Girma, Gebremedhin Desta, Saba Tsegaye, Melkamu Tesfaye
Journal of Integrative Nursing and Palliative Care.2023; 4(1): 108. CrossRef

Nursing
Association between perception of caring behaviors and self-efficacy in patients with cardiovascular disease at coronary care units: a cross-sectional study: Leila Kargar, Zahra Khademian, Masoume Rambod; Acute Crit Care. 2021;36(2):118-125. Published online April 29, 2021; DOI: https://doi.org/10.4266/acc.2020.00752

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212 Download
10 Web of Science
14 Crossref

Abstract PDF

Background
Assessing and improving patient self-efficacy are among the major roles of nurses. Nurses are also responsible for providing direct patient care, and they play a major role in improving patient care quality. Therefore, it is essential to evaluate nurses’ care-giving behaviors. This study aimed to determine the association between caring behaviors and self-efficacy in patients with cardiovascular disease.
Methods
In this cross-sectional study, 400 patients with cardiovascular disease who were admitted to hospitals in Jahrom, southern Iran, were selected through a stratified sampling. The Caring Behaviors Inventory and the Strategies Used by People to Promote Health questionnaires were used to collect data. Data were analyzed using descriptive statistics, Kolmogorov-Smirnov test and Spearman correlation coefficient in SPSS ver. 22.
Results
Results showed significant relationships between perception of caring behaviors and self-efficacy (r=0.16, P=0.001) as well as subscales of respectful deference to others (r=0.12, P=0.01), assurance of human presence (r=0.12, P=0.02), and positive connectedness (r=0.18, P=0.001). Additionally, among the subscales of caring behaviors, “attentive to others’ experience,” with a mean of 5.17±1.10, was the highest priority and “positive connectedness,” with a mean of 4.81±1.31, was the lowest priority for patients. The mean self-efficacy score was 73.94±29.78, and 169 patients (43.2%) had low self-efficacy.
Conclusions
Given the positive relationship between perception of caring behaviors and self-efficacy in patients with cardiovascular disease, self-efficacy could be improved by paying more attention to patient care priorities and improving patient perception of caring behaviors.

Citations

Citations to this article as recorded by

Structural equation modeling of caring behaviors and anxiety in nursing students during internship: the mediating role of ethical climate
Roya Dokoohaki, Masoume Rambod, Nilofar Pasyar, Ali Mohammad Parviniannasab, Maryam Shaygan
BMC Psychology.2026;[Epub] CrossRef
The Influence of Perception on Self-Efficacy Among Patients with Coronary Artery Disease in Indonesia: A Rasch Analysis
Aan Nuraeni, Firman Sugiharto, Anastasia Anna, Ristina Mirwanti, Yanny Trisyani, Etika Emaliyawati, Indah Lingga
Patient Preference and Adherence.2025; Volume 19: 1475. CrossRef
Compassionate care in nursing: The role of simulation-based compassionate care on nurse's caring behavior, self-efficacy and compassion competency
Rasha Mohammed Hussien, Tahani Khalil, Abdulqadir J. Nashwan, Hani Al-Najjar, Mahmoud Abdelwahab Khedr
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Caring behavior: perspectives from nurses and parents of hospitalized children
Mehri Ansariniaki, Seifollah Alaei, Mojtaba Khoshdast Kakhki, Majid Mirmohammadkhani
BMC Pediatrics.2025;[Epub] CrossRef
The relationship between psychological capital and humanistic caring ability among mental health nurses in Saudi Arabia
Atallah Alenezi, Fahad M. Alhowaymel, Abdulaziz F. Abaoud, Mona Hamdy Mostafa
BMC Nursing.2024;[Epub] CrossRef
Effectiveness of educational interventions for nurses caring for patients with chronic kidney disease in improving nurse outcomes: A systematic review
Yoke‐Yee Samantha Tai, Yu Hui Foo, Jeanette Ignacio
Journal of Clinical Nursing.2024; 33(3): 951. CrossRef
Self-efficacy in increasing physical activity of coronary heart disease patients: a cross-sectional study
Mulyanti Roberto Muliantino, Nindy Zumratul Qadri, Esi Afriyanti, Rika Sarfika
Jurnal Ners.2024; 19(3): 371. CrossRef
Self-efficacy in Doing Self-care Among Patients With Coronary Heart Disease: A Concept Analysis
Firman Sugiharto, Irianti Ubleeuw, Clausewitz Welmatus Masala, Fricilia Noya, Jerwilsem A. Latuheru, Dirman Abdullah, Bambang Priadi, Hartiah H Aroen, Aan Nuraeni
Malaysian Journal of Medicine and Health Sciences.2024; 20(5): 319. CrossRef
Patient Assessment of Care with Chronic Cardiovascular Disorders and Its Relationship with Self-Efficacy: A Cross-Sectional Study
Aidah Sanad Alqarni, Eddieson Pasay-An, Awad Eid Alshammari, Ferdinand Gonzales, Lorraine Estadilla, Kawther Eltayeb Ahmed, Lizy Sonia Benjamin, Andrew Ngo, Hanan Awad Moawad Elmashad, Dawlat Ahmed mahmoud Gharib, Salman Amish Alshammari
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Patient's perception of the quality of care in the Ambulatory Surgery Unit of the Polyclinic Hospital of the western area of the Metropolitan Area of Buenos Aires
Claudia Yanina Castillo
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A Scoping Review of Predictors Associated with Self-Efficacy Among Patients with Coronary Heart Disease
Firman Sugiharto, Aan Nuraeni, Yanny Trisyani, Azalia Putri, Nuraulia Armansyah, Asroful Zamroni
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The mediating role of psychological capital on the relationship between authentic leadership and nurses’ caring behavior: a cross-sectional study
Guowen Zhang, Wen Tian, Ying Zhang, Juanjuan Chen, Xiaohong Zhang, Wenfeng Lin, Huiping Li, Liqin Sun, Baozhen Cheng, Hui Ding, Guiqi Song
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Clinical Effectiveness of Nursing Care Delivery Models for Patients Following Hip Elective Surgery: Comparative Study
Zhangrou Rao†, Hui Shi†*, Zhezhen Jiang†, Jing Hu, Lanping Hu, Manjuan Xu, Regis Ernest Mendame Ehya, Guy-Armel Bounda*
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The Effect of Education Based on Human Care Theory on Caring Behaviors and Job Involvement of Nurses in Intensive Care Units
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